Conflict of Interests: The Esophageal Diagnostic Working Group was sponsored by Given Imaging, Inc. (Duluth, GA, USA). J.E. Richter: Given Imaging, Astra Zeneca, TAP; J.E. Pandolfino: Given Imaging, Sandhill Scientific, Crospon, Shire; M.F. Vela: Sandhill Scientific, Given Imaging; B.E. Lacy: Ironwood, Salix, Given Imaging, Prometheus, Takeda; T. DeMeester: Given Imaging; B.K. Oelschlager: Given Imaging, Torax, Olympus, Covidien,synovis; K.R. DeVault: Given Imaging; P.J. Kahrilas: Given Imaging, Eisai, EndoGastric Solutions, Ironwood, Torax, Reckitt Benckiser; J. Peters: Given Imaging; R. Ganz: Given Imaging; R. Fass: Given Imaging, Takeda, Reckitt Benckiser, Astra Zeneca, Vecta, Janssen; J. Conklin: Given Imaging; W.C. Dengler: Given Imaging; C.P. Gyawali: Given Imaging.
Utilization of wireless pH monitoring technologies: a summary of the proceedings from the Esophageal Diagnostic Working Group
Article first published online: 7 AUG 2012
© 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus
Diseases of the Esophagus
Volume 26, Issue 8, pages 755–765, November/December 2013
How to Cite
Richter, J. E., Pandolfino, J. E., Vela, M. F., Kahrilas, P. J., Lacy, B. E., Ganz, R., Dengler, W., Oelschlager, B. K., Peters, J., DeVault, K. R., Fass, R., Gyawali, C. P., Conklin, J. and DeMeester, T. (2013), Utilization of wireless pH monitoring technologies: a summary of the proceedings from the Esophageal Diagnostic Working Group. Diseases of the Esophagus, 26: 755–765. doi: 10.1111/j.1442-2050.2012.01384.x
- Issue published online: 14 NOV 2013
- Article first published online: 7 AUG 2012
- reflux monitoring
Gastroesophageal reflux disease (GERD) can be difficult to diagnose – symptoms alone are often not enough, and thus, objective testing is often required. GERD is a manifestation of pathologic levels of reflux into the esophagus of acidic, nonacidic, and/or bilious gastric content. However, in our current evidence-based knowledge approach, we only have reasonable outcome data in regards to acid reflux, as this particular type of refluxate predictably causes symptoms and mucosal damage, which improves with medical or surgical therapy. While there are data suggesting that nonacid reflux may be responsible for ongoing symptoms despite acid suppression in some patients, outcome data about this issue are limited. Therefore, this working group believes that it is essential to confirm the presence of acid reflux in patients with ‘refractory’ GERD symptoms or extraesophageal symptoms thought to be caused by gastroesophageal reflux before an escalation of antireflux therapy is considered. If patients do not have pathologic acid reflux off antisecretory therapy, they are unlikely to have clinically significant nonacid or bile reflux. Patients who do not have pathologic acid gastroesophageal reflux parameters on ambulatory pH monitoring then: (i) could attempt to discontinue antisecretory medications like proton pump inhibitors and H2-receptor antagonists (which are expensive and which carry risks – i.e. C. diff, etc.); (ii) may undergo further evaluation for other causes of their esophageal symptoms (e.g. functional heartburn or chest pain, eosinophilic esophagitis, gastroparesis, achalasia, other esophageal motor disorders); and (iii) can be referred to an ear, nose, and throat/pulmonary/allergy physician for assessment of non-GERD causes of their extraesophageal symptoms.